Helping Patients Heal: Learn What Adherence Actually Means to Them

I recently heard a story about a do-it-yourself home repair that turned into a nightmare when the homeowner fell and broke his femur, pelvis and elbow. As he recovered and the bones knit, his pain routinely woke him in the night. He did some research and decided it would be safe to take his medicine every six hours instead of the eight hours indicated by the prescribing physician. Because the new timing allowed him to take the medicine just before bedtime, he could sleep through the night. Weeks later, his primary care physician validated the safety of his approach.

I tell this story because it turns out many patients are taking a do-it-yourself approach to their health: They experiment, on their own, with how and when to take their prescription medicine. In fact, according to a study we did in conjunction with ReD Associates, 47% of patients explore different ways of taking their medications – definitely not the industry-approved idea of “adherence.”

During the study, our researchers shadowed individual patients and their families to get a firsthand perspective on how patients manage acute and chronic conditions and navigate their journey toward healing. Then we validated the field work with an extensive phone survey. The essence of what we learned is that when it comes to adherence, patients do what works for them. They will adjust and adapt treatments to fit their lifestyles and will judge success by how they feel and what they’re able to do. Our clinical measures and careful instructions don’t mean much to them.

Dealing With the Reality of Adherence

The implications of this finding are huge for the industry, which struggles with retaining clinical trial participants and proving the efficacy of therapies. Digital devices and apps are touted as ways to prevent patients from deviating from our instructions. Yet our research shows patients won’t follow directions that seem unrealistic, that greatly interrupt their lifestyle or that don’t help them get the results they want. We need to acknowledge that reality.

Instead of investing in “cold” solutions that reflect what works for the industry, life sciences companies must adapt to what we now know about patients and what adherence means to them. Here are a few suggestions:

Guide patient experimentation. Life sciences companies have an opportunity to educate physicians about how and why patients fail to follow exact instructions. Then physicians, not the Internet, can anticipate and guide patients toward finding safe, acceptable ways to integrate their prescriptions into their lifestyles. Our research shows that 37% of patients with chronic conditions who experiment without supervision tend to skip their medication “frequently” in a given month; that drops to 27% for supervised experimentation.

Connect clinical measures to patients’ life goals, including in clinical trials. Our study showed people will pay more attention to a clinical measure such as blood sugar levels when they understand how it relates to their ability to meet an objective that’s important to them, whether that’s riding a new motorcycle or playing on the floor with the grandkids. We can design digital tools that help patients track success with meeting personal goals and correlate these “wins” to clinical metrics so patients can see the impact of their adherence behavior on their goals. This could help in clinical trial retention too, enabling participants to see the value in their own lives of completing the trial.

Provide personalized and integrated patient support. Every patient in our study has a unique story on how they’re coping with their condition, but the information available to them is generic. Time and again, patients expressed frustration with their quest to find information through websites and apps.

Patients want personalized support designed to address their specific situations, such as the parents we met trying to balance their son’s desire to play soccer with an order from his physician to avoid asthma triggers. We can learn from FANG companies about how to make information intuitive and adaptive to different personas rather than one-size-fits all.

Help the physician hear the patient. We learned people are three times more likely to adhere to their drug regimen when they feel confident their physician heard all they had to say. Patients want to tell the story behind their health situation, not just make marks on an intake form. Digital solutions that facilitate patient-physician interaction, allowing them to provide a holistic but concise view of health, can make a significant impact on breaking the information barrier between patient and physician.

Wrap products in services that transcend medicinal value. Medical measurements, live support and remote monitoring need to be tailored to patient needs and behaviors. Many digital efforts are designed to collect data or prompt patients to act; digital solutions need to be warmer and offer advice and capabilities, like personal goal tracking, that patients want. Goals should always be expressed in a language that patients can understand.

Make sure the patient has agency. The conventional wisdom has been to limit what’s asked of the patient to make adherence simple. In contrast, our study showed patients will put a lot of effort into managing their care and wellness – when success is measured on their terms. Digital solutions can help patients feel more in control of their health and treatment by being personal and providing choices vs. simply telling the patient what to do.

Using Digital to Close the Gap

Digital tools and strategies can help life sciences companies implement these tactics. Digital can be warm, personalized, adaptive and context-aware – all the qualities patients want. Digital can also equip physicians with tools and information to help them guide patient efforts to integrate treatment into their lifestyles.

The challenge will be for the industry to really hear patients. Companies that embrace these findings and adapt to how patients take (or don’t take) their medicine will be on the path toward helping people heal – with positive clinical outcomes and achievement of personal goals.

Pratik Maroo, Cognizant’s Chief Digital Officer for Life Sciences, contributed to this blog.